Carl read the papersWhat it actually is
Amylin is a hormone your pancreas releases alongside insulin after you eat. In type 1 and type 2 diabetes, the beta cells release less of both. Pramlintide is a 37-amino-acid copy of human amylin with three positions swapped for proline.
It was approved by the FDA in 2005 as Symlin, as an add-on for people with type 1 or type 2 diabetes who use mealtime insulin and still are not at target. It never got a weight-loss licence, though it was trialled for obesity. It belongs to the same hormone family as cagrilintide, the long-acting amylin analogue in CagriSema.
How it’s thought to work
- Appetite — Amylin regulates food intake through the brain; in people, pramlintide modulates satiety and cuts calorie intake.
- Slowed gastric emptying — Food leaves the stomach more slowly, without changing total nutrient absorption.
- Less glucagon after meals — Blunts the after-meal glucagon rise, so the liver releases less sugar.
- Short half-life — About 48 minutes in healthy people, which is why it goes in before each main meal.
What the research says
Approved on diabetes data, with a smaller obesity programme on the side. In the type 1 diabetes label trials, people lost 0.8 to 1.6 kg on it while placebo groups gained a little. In obesity, a 16-week trial (n=204) gave 3.7% more weight loss than placebo, and a 12-month trial (411 randomised, 146 still assessed at 12 months) gave 6.1 to 7.2 kg more than placebo on the better regimens, with 40 to 43% losing at least 10% (vs 12% on placebo). Paired with leptin in a 24-week proof-of-concept trial, weight loss reached 12.7%. Real effects, modest size.
- 16-week obesity trial (n=204): 3.7% placebo-corrected weight loss; 31% lost at least 5% vs 2% on placebo.
- 12-month obesity trial (411 randomised, 146 assessed at 12 months): 6.1 to 7.2 kg placebo-corrected on 120 mcg three times daily or 360 mcg twice daily.
- With leptin (24 weeks): 12.7% weight loss, more than either alone; a research combination, not a product.
- Nausea is the main side effect: 9 to 29% vs 2% on placebo in the 4-month obesity study, fading later.
Reported protocols
These are the doses the peptide community actually reports running (Reddit & forums), alongside published research — logged for education, not as a recommendation to use.
| Parameter | Commonly reported range |
|---|---|
| Label dose, type 2 | 60 mcg right before each major meal, up to 120 mcg once there has been no significant nausea for 3 days |
| Label dose, type 1 | 15 mcg before each major meal, up in 15 mcg steps to 30, 45 or 60 mcg; back to 30 mcg if nausea persists |
| Insulin rule | Mealtime insulin is cut by 50% when starting. This is the boxed-warning part: severe lows can hit within 3 hours |
| Obesity trial doses | Studied, not approved: 120 mcg three times daily or 360 mcg twice daily (12 months), and up to 240 mcg three times daily (16 weeks) |
| Route | Subcutaneous, abdomen or thigh. The label says not the arm, because absorption varies |
| Community dose | Not established. The public reports we found are diabetics on prescription Symlin, not off-label users |
| Prescription | A prescription medicine with a boxed warning; not something to run without a doctor |
Common use cases
| Goal | Community protocol notes |
|---|---|
| Type 1 diabetes on mealtime insulin | the approved use: 15 to 60 mcg before meals, insulin cut by half to start |
| Type 2 diabetes on mealtime insulin | the approved use: 60 to 120 mcg before meals |
| Weight loss | trialled in obesity but never approved for it |
Mixing it (reconstitution)
Freeze-dried peptides must be reconstituted with bacteriostatic water before they can be measured. Carl’s calculator turns “mg in the vial + ml of water + target dose” into “units on the syringe” — and tells you how long the vial lasts.
→ Open the Reconstitution Calculator
Injection & handling
Injected under the skin of the abdomen or thigh, immediately before each major meal, which the label defines as at least 250 kcal or 30 g of carbohydrate. Not the arm. Let it reach room temperature to cut site reactions, use a different spot from your insulin, and never mix it with insulin. Step up only after 3 nausea-free days. Because it slows the stomach, oral tablets that need to work fast go in 1 hour before or 2 hours after it. There is no weekly pramlintide; for a weekly amylin analogue, see cagrilintide.
Stacks it appears in
- With a GLP-1 — Amylin plus GLP-1 is the CagriSema idea, which reached 20.4% weight loss at 68 weeks (vs 3.0% on placebo) using weekly cagrilintide. Doing it with pramlintide means extra shots before every meal, and we found no trial of that version.
- With leptin — Pramlintide plus recombinant leptin reached 12.7% in a 24-week trial. A research combination only.
Sources
- FDA label: SymlinPen (DailyMed, Dec 2019 version)
- FDA Drug Shortages: pramlintide (SymlinPen 60 and 120)
- Drugs@FDA: NDA 021332 (Symlin)
- Aronne et al., pramlintide in obesity, J Clin Endocrinol Metab 2007 (PMID 17504894)
- Smith et al., 12-month pramlintide in obesity, Diabetes Care 2008 (PMID 18753666)
- Roth et al., amylin agonism restores leptin responsiveness, PNAS 2008 (PMID 18458326)
- Garvey et al., REDEFINE 1 (CagriSema), N Engl J Med 2025 (PMID 40544433)
- SAHPRA: Peptide Products, Public Information (May 2026)
- WADA 2026 Prohibited List
